Multidisciplinary treatment for patients with advanced hepatocellular carcinoma complicated by Vp4 portal vein tumor thrombosis: Combination of atezolizumab and bevacizumab after hepatic arterial infusion chemotherapy and radiotherapy: A case series

Abstract

Rationale: Various treatments are available for treating hepatocellular carcinoma (HCC). Among HCC, Vp4 portal vein tumor thrombosis (PVTT) has a poor prognosis. There have been reports of treatment with molecularly targeted agents in combination with hepatic arterial infusion chemotherapy (HAIC) and radiotherapy (RT) in HCC patients with Vp4 PVTT, but none with atezolizumab, the immune checkpoint inhibitor. Here, we present cases of unresectable HCC with Vp4 PVTT that were treated with the combination atezolizumab and bevacizumab (Atezo + Bev) after HAIC and RT. The purpose and significance of this study are to research the usefulness to precede HAIC and RT in the treatment of HCC with immune checkpoint inhibitors. Patient concerns: Sixty-six-year-old man, 74-year-old man, 83-year-old man, 69-year-old man, 62-year-old man, and 85-year-old woman were diagnosed with HCC with Vp4 PVTT. Diagnosis: Cirrhosis was classified as Child-Pugh class A or B. HCC was diagnosed as TNM stage IVa or IVb. Interventions: RT for PVTT was performed the same day or the day after HAIC. Atezo + Bev was started at least 1 week after RT was completed. Outcomes: Death was confirmed in 4 of the 6 patients; the median overall survival time was not reached. The survival times of the 4 patients were 18.7, 12.5, 5.1, and 1.7 months. Based on the modified response evaluation criteria in solid tumors criteria, the objective response rate of patients with best tumor response to Atezo + Bev therapy was 66.7%, and that of patients with best response of PVVT to Atezo + Bev was 66.7%. Lessons: These cases showed that in HCC with Vp4 PVTT, HAIC, and RT before Atezo + Bev may be useful to prolong survival.